皮肤恶性黑色素瘤(cMM)可以在任何部位发展,但是三分之一的病例主要影响下肢,脚踝和足部病变占所有病例的3-15%。然而,当cMM表现为临床上与糖尿病患者的其他下肢溃疡难以辨别的慢性溃疡时,cMM可能成为临床难题。我们介绍了一个71岁的女性患者,有长期的糖尿病史,高血压,肥胖,慢性肾脏病和心力衰竭患者出现足跟溃疡到我们医院就诊。该病变最初在另一家医院作为神经性糖尿病足溃疡(DFU)进行管理,通过多个局部伤口清创术治疗。然而,溃疡进展为足跟损伤,影响患者的活动能力和生活质量。因此,该患者被转介至我们的糖尿病足专科服务进行进一步治疗。病灶的切除活检显示了cMM。正电子发射断层扫描/计算机断层扫描显示高代谢同侧腹股沟淋巴结病,和右脑转移开始姑息化疗。考虑了免疫疗法,但病人在开始之前就死了.糖尿病患者的非典型足部溃疡需要谨慎的诊断方法,特别是对于对标准疗法没有反应的顽固性皮肤病变。认真管理,在获得组织病理学诊断方面没有不适当的延迟,可能导致黑色素瘤的早期诊断和潜在的更有利的结果。这个案例突出了考虑不典型足部病变的重要性,在一般实践中,除了转诊中心,试图识别令人震惊的特征并采取相应的行动。
Cutaneous malignant melanoma (cMM) can develop at any site, but one-third of cases primarily affect the lower extremities, with ankle and foot lesions representing 3-15% of all cases. However, cMM may become a clinical conundrum when it presents as chronic ulceration that is clinically indiscernible from other lower extremity ulcers in patients with diabetes. We present the case of a 71-year-old female patient with a longstanding history of diabetes, hypertension, obesity, chronic kidney disease and heart failure who presented to our hospital with a fungating heel ulcer. The lesion was initially managed in another hospital as a neuropathic diabetic foot ulcer (DFU), treated by multiple local wound debridement. However, the ulcer progressed into a fungating heel lesion that interfered with the patient\'s mobility and quality of life. Consequently, the patient was referred to our specialist diabetic foot service for further management. Excisional biopsy of the lesion disclosed a cMM. Positron emission tomography/computed-tomography scanning revealed hypermetabolic ipsilateral inguinal lymphadenopathy, and a right cerebral metastasis for which palliative chemotherapy was initiated. Immunotherapy was considered, but the patient died before it was started. Atypical foot ulcers in patients with diabetes warrant a careful diagnostic approach, especially for recalcitrant cutaneous lesions not responding to standard therapies. Conscientious management, without undue delay in obtaining a histopathological diagnosis, might lead to early diagnosis of melanoma and potentially more favourable outcomes. This case highlights the importance of consideration of atypical foot lesions, in general practice in addition to referral centres, to try to identify alarming features and act accordingly.